Dr. Christopher A. Yeung, M.D. Phoenix, On The SMART Clinical Trial For Low Back Pain
Dr. Christopher A. Yeung of Desert Institute for Spine Care in Phoenix, AZ graduated magna cum laude from the University of California San Diego, and was in the top five percent of his medical class at The University of Southern California School of Medicine. Dr. Yeung completed an orthopedic residency at the University of California Irvine Medical Center. He then did a spine surgery fellowship at USC Center for Orthopedic Spine Surgery/Los Angeles Spine Surgery.
Desert Institute for Spine Care (DISC) and Dr. Yeung in particular, have played a rule role in investigative FDA studies focusing on lower back pain and its treatment. Dr. Yeung has been the principal investigator in many FDA studies including the Flexicore lumbar artificial disc substitute, Cervicore cervical artificial disc substitute, and DASCOR total nucleus substitute. Dr. Yeung and the team at DISC are always strive to be among the first to get these inventive techniques approved and obtainable to those experiencing from weakening back pain.
Presently Dr. Yeung is heading up an investigational study to estimate the benefits and efficacy of the Intracept Procedure, a one-hour treatment designed to treat chronic low back pain at its source. The SMART Clinical study is being conducted at several different locations throughout the country to determine whether this one-hour outpatient procedure, in which a probe is progressive into the vertebrae and positioned at the basivertebral nerve, is effective at eliminating low back pain with minimal intrusion to the patient.
Radiofrequency energy is delivered directly into the nerve rendering it unable to produce pain signals. Only those individuals with lower back pain that does not extend into the lower extremities are eligible for participation in the SMART Clinical study. This procedure is potentially effective at treating low back pain that is concentrated only in the lower back and does not radiate into the lower body.
We took a few minutes of Dr. Yeung’s busy schedule to ask him about the Intracept Procedure and how it may be on the cutting edge of minimally invasive spinal surgery.
Doctor, what made you get involved in the SMART Clinical Trial and how is this procedure different from other options that are obtainable?
Doctor Yeung: The Company approached us because of our experience in minimally invasive spine procedures. We do a lot of percutaneous endoscopic discectomy kind of work and so they approached us to get involved in this new study.
I think one of the reasons was because it is a truly minimally invasive way to treat vertebrogenic degenerative back pain. Instead of a big open surgery, it’s truly treating the pain by a small incision, essentially like a large needle, which allows a probe to go into the vertebral body and basically ablate or burn the nerve that transmits the pain from the vertebral body.
For us, it was really exciting to be a part of this study and we are honored to be a part of this study because it could revolutionize the treatment of degenerative disc disease and vertebrogenic back pain. It’s very exciting because it is a big difference compared to open fusion.
Who would assistance from this procedure and how would someone qualify? Does this procedure treat all types of low back pain? Is there any kind of hospitalization involved and what is the cost to the patient?
Dr. Yeung: There is no cost to the patient. The study sponsor absorbs all the cost of the treatment. The patients that would assistance from this are people with chronic low back pain without any sciatica or radiculopathy, they don’t have any nerve compression. Nerve compression would cause pain going down the legs, if they have nerve compression they would be excluded from the study.
People with chronic back pain from the vertebral bodies are the people who would qualify for this. A lot of times it’s difficult to tell where the back pain is coming from because there is so many structures in the back that can be causing pain. It could be the vertebra and those are the patients that would qualify or it could be the actual disc itself or it could be the facet joints in the back or maybe the muscles and the ligaments.
It’s sometimes difficult to figure out where the actual pain is coming from but for the study they are using MRI criteria. People who have chronic back pain and on the MRI they have inflammatory changes or degenerative changes in the vertebral bodies themselves, those are the people that would qualify.
Those changes that we are looking for are called MODIC changes. We want to try to eliminate the people that have pain coming from their facet joints and looking mostly at people with pain coming from pressure across the vertebral bodies. As the discs degenerate and collapse they are not an effective cushion between the two vertebral body bones. This causes more pressure across those bones and they get inflamed and you can see some chronic bony changes and those are the people we are targeting.
There is a nerve called the basil vertebral nerve that goes into the vertebral body and it branches out and innervates the weight bearing surfaces of those vertebral bodies. The study is designed to go in and ablate or burn that nerve so that basically you can short circuit the pain response from those vertebral bodies in plates.
Doctor, how long does the surgery take with this procedure?
Dr. Yeung: Typically if you’re treating two vertebral bodies that would be like an L4 and L5 vertebral body and would be on either side of the L4 or L5 disc. That would probably take about an hour and ten minutes for the procedure. At each level you have to heat the nerve for about fifteen minutes each. The set up usually takes about an hour. You don’t get general anesthesia, it is just local anesthetic and some sedation.
Is this technique the future of treating low back pain? Will this replace other methods of treatment for this specific kind of back pain?
Dr. Yeung: I don’t think it will replace everything completely. I think it’s another weapon in our fight against back pain. It can basically prolong the need for large fusion and also obviate the need for fusion.
If someone has degenerative disc disease and vertebrogenic back pain, right now the option is live with it or get fusion or disc substitute surgery. This can hopefully alleviate the pain from the source, from the nerve and then the patient won’t need to have that reconstructive spine surgery if their pain is relieved.
Hopefully this pans out and it’s effective. That’s what the study is designed to figure out.
How can someone find out if they are eligible for this study? Where would they go for more information?
Dr. Yeung: The best place would be the website. On the website it shows all the participating sites across the country. Hopefully there is one close to that person that is seeking more information. I think there is contact information there also. They can contact the company or if they are in Phoenix, Arizona they can just contact my clinic directly. DISC has clinics in Phoenix, Scottsdale, and Gilbert, Arizona. There are about fifteen clinics across the country they can contact.
What are some of the characteristics that differentiate Desert Institute for Spine Care from other practices?
Dr. Yeung: One of the things that differentiates us from other clinics is our ability to offer a complete spectrum of treatment from injection treatment to minimally invasive techniques. We can do endoscopic discectomy that not a lot of people know how to do. It is a seven millimeter incision that’s like scoping the knee so we can offer that to patients for herniated discs and that’s probably the biggest differentiator for us, not a lot of people can offer that.
We also offer all the traditional treatments such as fusion and open laminectomies when that’s appropriate and they are not appropriate for the minimally invasive techniques. We offer a complete spectrum of care from non-operative to bigger open surgeries with all the specialized minimally invasive techniques. We are also one of the few clinics that aim a lot of people so we travel a lot to teach.
I’m here in New York to conduct a course to help aim other neurosurgeons out here on the technique.
My dad, myself and other partners, we travel all around and lecture about this and help teach it in cadaver labs. We sustain a lot of research and participate in FDA studies. Some of the newer cutting edge technologies that are being studied can be offered here for appropriate patients.
Doctor Yeung, thank you for your time and providing insight into Intracept Procedure and its possible benefits.
Dr. Yeung: You’re welcome.
Dr. Christopher Yeung, MD, Desert Institute for Spine Care, can be contacted at 602-944-2900. For more information on DISC Phoenix, Scottsdale, and Gilbert clinics, visit: sciatica.com. For more information on The SMART Clinical Study and the Intracept Procedure contact Desert Institute for Spine Care directly at 602-944-2900 or visit http://www.smartclinicalstudy.com.
Kevin Nimmo is a writer and online media strategist. He interviews subject matter experts and educates his readers based on information provided by experts in their respective fields. He is also Executive Editor of The Western Medical Journal.
By Kevin Nimmo